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General NPI Number Information
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NPI Number | 1639822521
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Entity Type | Organization
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Legal Business Name | ESTACADA EYECARE PC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 405 NE MAIN ST
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City | ESTACADA
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State | OR
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Zip | 97023-8528
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Country | US
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Telephone | 503-630-3528
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 358
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City | ESTACADA
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State | OR
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Zip | 97023-0358
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Country | US
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Telephone | 503-630-3528
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMRITA KANG
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Credential | OD
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Telephone | 503-462-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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